Only second heterotopic twins in medical history to survive

Hadassah team saves Cypriot mother and twin girls - one growing inside and other outside uterus.

neri laufer 311 (photo credit: Hadassah Hospital)
neri laufer 311
(photo credit: Hadassah Hospital)

Twin Cypriot baby girls - one growing insidetheir mother's uterus and the other having developed with the placentaattached to the exterior of the uterus and the sigmoid colon - havebeen born healthy at Hadassah University Medical Center in Jerusalem.Theywere the second such case in the last 25 years. A multidisciplinaryteam of 15 doctors worked in perfect synchrony to save the 34-year-oldmother, whose body was described as a "ticking time bomb" as well asthe babies born in their 28th week of gestation.

The excited father told The Jerusalem Post thatthe Hadassah team's saving of his wife and his daughters was a"miracle. We would not have come if we did not think they would saveall of them," he said.

The government of Cyprus paid for the procedure, and he isstaying in the meantime in the Ein Kerem Hotel attached to thehospital. "I am very happy with Hadassah and the level of Israelimedicine. We are very grateful. I don't know how to explain what Ifeel. We were very happy to come here," he added. "When our girls arebig enough, we for sure want to visit again and see again the doctorsand nurses, who were perfect."

Highly complex surgery to delivery the third-trimesterheterotopic pregnancy took three hours to prepare and two more hours toperform. If not done properly and in time, it would have ended in thedeath of all three. Hadassah doctors studied the medical file of thefirst successful case in France from a decade ago and pulled together askilled team that included two obstetricians, an angiologist, aurologist, intestinal and vascular surgeons, neonatologists and seniorultrasound and MRI scanning experts.

Prof. Neri Laufer, chairman of the department of obstetrics and gynecology at the Ein Kerem medical center, told The Poston Sunday that the girls are attached to respirators but doing verywell, even though they are 12 weeks' premature. The first to be bornvia cesarean section after spending her gestation inside the wombweighed 970 grams at her birth on Thursday night and was given the nameMarialena. Her sister Georgia Nicolleta, who spent the same periodoutside the womb and received nourishment when the placenta attacheditself to the outside of her mother's uterus and colon, weighed 930grams.

Laufer explained that factory worker Elsa Georgiou Neokleousand her 28-year-old husband Lucas learned at a late stage in a Cyprushospital that one twin was in the uterus and one outside. Doctors didnot know how to save her and the twins and contacted Israel, whereHadassah doctors agreed to handle the case despite the fact that in allof medical history, only two previous infants had survived such aprocedure.

Laufer said that one embryo apparently escapedfrom one fallopian tube that had been cut during the in-vitrofertilization procedure carried out in Cyprus. In one percent ofpregnancies, an embryo develops outside the uterus, and in 5 percentare there twins, one inside and one outside. This happens in one out of300,000 cases of IVF. But in the vast majority of cases, heterotopicpregnancies are discovered during the first three months of pregnancyand terminated because of the danger to the mother's life. If leftinside, the mother has a 10% to 20% risk of dying. If not, the fetusesface a 70% to 95% risk of dying in the mother's body during the secondtrimester; surviving into the third trimester is almost impossible.

During the open abdominal surgery to deliver them, anuninflated balloon was inserted into the mother's aorta just in case,to be inflated and stop blood from gushing out of any arterial holethat might have been made by the invasive placenta.

Laufer said that as one ovary remains normal and the uterusseems to be whole, the woman could very well be able to have additionalchildren in the future with IVF.